Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Validação de álbum seriado para promoção do aleitamento materno Validación de un álbum seriado para la promoción de la lactancia materna Validation of a flip chart for promoting breastfeeding

OBJETIVO: Validar um álbum seriado a respeito da autoeficácia em aleitamento materno quanto ao conteúdo e à aparência. MÉTODOS: Com base na versão traduzida da Breastfeeding Self-Efficacy Scale - Short Form foram elaboradas sete ilustrações e suas respectivas fichas-roteiro. Realizou-se a validade aparente (clareza/compreensão) e a validade de conteúdo (relevância) com base na avaliação de dez juízes. RESULTADOS: As considerações dos juízes foram acatadas em relação à clareza/compreensão. O Índice de Validade de Conteúdo foi 0,92 quanto às figuras e 0,97, quanto às fichas-roteiro, caracterizando o álbum seriado como uma estratégia válida. CONCLUSÕES: O álbum seriado pode ser utilizado nos diversos campos de atuação da enfermagem, inclusive no alojamento conjunto.<br>OBJETIVO: Validar un álbum seriado respecto a la autoeficacia de la lactancia materna en cuanto al contenido y la apariencia. MÉTODOS: Con base en la versión traducida de la Breastfeeding Self-Efficacy Scale - Short Form se elaboraron siete ilustraciones y sus respectivas fichas-guía. Se llevó a cabo la validez aparente (claridad/comprensión) y la validez de contenido (relevancia) mediante la evaluación de diez jueces. RESULTADOS: Las consideraciones de los jueces fueron acatadas en relación a laclaridad/comprensión. El Índice de Validez de Contenido fue de 0,92 en cuanto a las figuras y de 0,97, en cuanto a las fichas-guía, caracterizando el álbum seriado como una estrategia válida. CONCLUSIONES: El álbum seriado puede ser utilizado en los diversos campos de actuación de la enfermería, inclusive en el alojamiento conjunto.<br>OBJECTIVE: To validate a flipchart with respect to self-efficacy in breastfeeding, regarding its content and appearance. METHODS: Based on the translated version of the Breastfeeding Self-Efficacy Scale - Short Form, seven illustrations and their respective flipcharts were prepared. Face validity (clarity / understanding) and content validity (relevance) were performed based on the evaluation of ten judges. RESULTS: The judges considered the methods were successful in relation to clarity / understanding. The Content Validity Index was 0.92 as to the figures, and 0.97 as to the script, characterizing the flipchart as a valid strategy. CONCLUSIONS: The flipchart can be used in various areas where nursing is practiced, including shared patient rooms

Elevations of inflammatory proteins in neonatal blood are associated with obesity and overweight among 2-year-old children born extremely premature

BACKGROUND: Childhood obesity is associated with elevated blood concentrations of inflammation markers. It is not known to what extent inflammation precedes the development of obesity. METHODS: In a cohort of 882 infants born before 28 weeks of gestation, we examined relationships between concentrations of 25 inflammation-related proteins in blood obtained during the first two postnatal weeks and body mass index at 2 years of age. RESULTS: Among children delivered for spontaneous indications (n=734), obesity was associated with elevated concentrations of four proteins (IL-1β, IL-6, TNF-R1, and MCP-1) on the first postnatal day; one protein (IL-6) on postnatal day 7; and two proteins (ICAM-3 and VEGF-R1) on postnatal day 14. Among children delivered for maternal or fetal indications (n=148), obesity was associated with elevated concentrations of seven proteins on the 14th postnatal day. In multivariable models in the spontaneous indications subsample, elevated IL-6 on day 1 predicted obesity (odds ratio: 2.9; 95% confidence limits: 1.2, 6.8), while elevated VCAM-1 on day 14 predicted overweight at 2 years of age (odds ratio: 2.3; 95% confidence limits: 1.2, 4.3). CONCLUSIONS: In this cohort, neonatal systemic inflammation preceded the onset of obesity, suggesting that inflammation might contribute to the development of obesity.Pediatric Research accepted article preview online, 15 December 2017. doi:10.1038/pr.2017.313